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Biomedical subjects

T Winter

Publications and source records attributed to T Winter.

51 records · Page 3Linked to original sources
PubMed1992

Triple therapy with sucralfate is as effective as triple therapy containing bismuth in eradicating Helicobacter pylori and reducing duodenal ulcer relapse rates.

Duodenal ulcer relapse rates after therapy with sucralfate or bismuth are lower than those after H2-receptor antagonist therapy. This may be mediated by an antibacterial effect of these drugs on Helicobacter pylori. Bismuth has become an integral part of 'triple therapy' because of its documented anti-H. pylori effect. In vitro and clinical data suggest that sucralfate may also have an anti-H. pylori effect. The aim of this randomized, prospective therapeutic trial was to compare the efficacy of triple therapy containing bismuth with that containing sucralfate and to determine the effect of therapy with these combinations on duodenal ulcer relapse. Forty H. pylori-positive duodenal ulcer patients were healed with omeprazole and randomized to receive either 1 g sucralfate four times daily or 120 mg bismuth compound four times daily. All patients received 400 mg metronidazole three times daily and either 250 or 500 mg tetracycline four times daily for 7-14 days. Thirty-five patients could be analysed. Overall eradication rates did not differ in the treatment groups (10 of 17 eradicated with sucralfate and 11 of 18 with bismuth). Relapse rates were significantly lower in the eradicated group (1 of 21 compared with 8 of 14 in the non-eradicated group) and did not differ between treatment groups in those patients not eradicated. A triple therapy regimen utilizing sucralfate appears to be as effective as the bismuth-containing regimen.

Bismuth↗
PubMed1989

[Percutaneous drainage of fistula-associated abscesses and biliary fistulas].

33 abdominal abscesses associated with fistulae in 31 patients were treated by percutaneous drainage. 19 of these patients had had surgery immediately preceding the drainage. In 64% the percutaneous drainage led to a diagnosis of an internal fistula. Additional therapeutic measures, because of the fistula, were necessary in 45% (operation, biliary drainage, repositioning of catheter). The average duration of drainage was 29 days. 77% of those abscesses which could be drained were treated successfully. Mortality in the entire series was 19%.

Abdomen↗
PubMed1989

[Percutaneous drainage treatment of abscess and fluid retention following abdominal surgery].

61 patients with abdominal abscesses and fluid collections as a postoperative complication underwent percutaneous drainage. 60 abscesses, 11 haematomas, 3 steril seromas and 3 bile collections were drained. The fluid collections were associated with biliary or enteric fistulae in 16 cases. The percutaneous drainage was successful in 69%, additional surgery was required in 15%. The overall mortality rate was 13%. Reasons for drainage failure were infected clots, phlegmonic abscesses and pancreas involvement of the abscesses.

Abdomen↗
PubMed1989

[Report of experiences with 31 surgically treated patients with deformity of the femur shaft].

In 1986/1987 we made a follow-up of 31 patients having undergone a surgical treatment of a deformity of the femur shaft in 1971 through 1981. For a better interpretation of the results we divided these patients into three partly overlapping groups: Patients with deformities of the angel or rotation, patients being shortened in case of length-differences and those being elongated. Finally we investigated, that in nine out of ten cases we got a good result by correcting angle-and rotation-deformities and by the shortening osteotomy. The extension osteotomy caused more complications and not so good results than those of the first two groups. We recognized, that the follow-up treatment was very long, and the method of the operation was not standardized but was adapted to the circumstances of the single case.

Bone Diseases↗
PubMed1985

[Arthrodesis of the upper ankle joint following trauma. Follow-up study].

During a period of more than 20 years, 63 patients having undergone a trauma were submitted to arthrodesis of the upper ankle joint. 31 out of them could be followed up from autumn 1982 through spring 1983. The primary reasons and the individual courses making necessary the arthrodesis varied to such an extent that there were no identical anamneses in any of the patients. The destruction of the upper ankle joint by high kinetic energy was apparently an essential factor in the anamnesis of arthrodesis of the upper ankle joint. There is no correlation between the number of posttraumatic arthrodeses and the number of fractures of the ankle joint treated by surgery during the same period. A "good" or "satisfactory" result was achieved in nine out of ten cases submitted to arthrodesis, and it seemed to be unimportant which of the usual techniques was applied. The high complication rate reported in literature, too, has possibly to be considered as a consequence of the gravity of the disease. It seems to be independent of the previously existing risk factors. The follow-up period is very long.

Adult↗
PubMedDate not supplied

[Unreported cases--obstacle to exact research in clinical orthopedics and traumatology].

In number 2 1991 of the "Orthopädie Mitteilungen" we referred to problems in obtaining valid data in orthopaedics and orthopaedic traumatology. There we mentioned several unknown cases in the epicrisis related to anamnestic facts. Now we continue the report with the support of our completely quality checked basis documentation. The comparison of the operation-report and the epicrisis shows us that data in three out of four cases are identical. We get nearly the same result, if we compare the operation-site (left or right are in four out of five cases identical). Furthermore we discuss a critical research of aneurysmatic bone cysts out of 24,000 epicrisis. Research into benign tumors or tumorlike lesions is very difficult, because the patients normally leave the hospital before the exact diagnosis was made. Therefore we must take into account uncertain results of our investigations. As far as possible our results take into account rare bibliographic data. Therefore we can show that our modified documentation of all epicrisis should be preferred to documentation of specific forms. Furthermore the investigation demonstrates, that our "frame coding system" is superior to a "precise coding system" for the precise system does not regard the background of the inquiries. But considering the background, we are able to discover most of the unknown cases and make them part of our conclusions.

Humans↗
PubMedDate not supplied

[Basic differential documentation as conditio sine qua non for effective quality assurance].

The quality check in medicine increases not at all by judges order. This contribution shows in what point of medical-documentation quality check must begin, if she should be effective. Some examples explain, that only a discriminated and a by specialist examined basic documentation is able to give us valid statistics of clinical data. Some results of our quality checked basis documentation were presented too.

Cross-Sectional Studies↗
PubMedDate not supplied

[Additional coding for legally required ICD-9 as the basis for high quality patient record searches].

We are convinced, that the updating of the ID DIACOS diagnosis catalogue fits better to the today's medical language, than the former one. By using a consequent additional code we could eliminate several lacks of the ICD-9. Valid and reproducible diagnosis statistics are now possible. Subjective coding mistakes are largely avoidable. Inquiries of certain diagnosis can be answered by using the one of the two codes, that describes the diagnosis in the best form. Regarding the allotments of the best form. Regarding the allotments of the catalogue of orthopedic and traumatic diagnosis including the possibility of double-coding we got a special better version of ID DIACOS than before.

Data Collection↗
PubMedDate not supplied

[Use of statistical procedures in orthopedics exemplified by several years of an orthopedic specialty journal].

As expected, it was found that mainly graphic and tabular methods were used, unless the papers in question were purely descriptions of methods or brief case reports. This is probably connected with the long courses of orthopedic conditions, which, with a reasonable investment in time, can only be studied retrospectively. Nevertheless, it became apparent that the group of prospective studies, though numerically smaller, had by and large been performed quite well. Many of them managed without test statistics and yet have considerable information value. The few reports with test statistics had for the most part also been quite well conducted. The most common sources of errors in these were that too many tests were conducted on the same data material without taking the cumulative probability of error into account, e.g., according to Bonferroni-Holm; and the test method used was often not mentioned. So some good statistical studies in orthopedics are certainly being published, albeit gradually. It is planned to conduct a similar investigation on the same years' issues of a German-language journal in another specialty included in the list mentioned at the beginning--German to avoid the bias of translation. Afterwards the two studies can be compared to establish whether an orthopedic journal cannot also be included in the list of the 200. The necessity of impeccable statistics for practice and research is undisputed. The results presented here are intended to encourage orthopedists to attempt prospective studies more frequently than hitherto, and, keeping the test preconditions in mind, also to use correctly described, conclusive statistics.

Clinical Trials as Topic↗
PubMedDate not supplied

[Results of voluntary and mandatory statistics 1986/87--including a comparison with the preliminary study 1984/85. Scope of the topic: experiences after 2.5 years of the federal directive on operating cost rates of 1985].

The absolute necessity of checking documentation received was reported on, as well as the fact that the legislature cannot assume that one can draw conclusions from one year about the following year. It was shown that the introduction of new methods can considerably affect diagnosis statistics, and pointed out that easier research into complications was one positive effect of the--externally induced--more detailed formulation of medical reports. Since, in our 10,000-patient orthopedic-traumatologic clinic, we had to state every fourth ICD-9 figure including the V-classification, it would not be possible in our case to cover the entire hospital with just a few code numbers. Furthermore, it has so far proved right, in spite of the stipulation to use ICD-9, to perform basic documentation using our in-house code. This appears indispensable to us, particularly considering the error rate when decoding ICD-9 data.

Bone Diseases↗
PubMedDate not supplied

[Use of electronic data processing in larger orthopedic clinics. Results of a survey].

In a survey of 93 orthopedic clinics or departments conducted in 1985, concerning the use of data processing systems, a total of 64 replies were received. These were not yet affected by the new Federal (German) Hospital Tariffs Regulations and therefore reflect the actual needs of the institutions in question. There is a clear trend toward using data processing for scientific purposes. Data processing systems were already in use in 42 institutions. There are hardly any differences between university clinics and non-university establishments. It is significant that among the key systems used in orthopedic medicine, ICD9 plays a completely subordinate role. This is seen as proof that ICD9 is inadequate for orthopedic purposes. Attention is drawn to a simple diagnostic key used by the Oskar-Helene-Heim. The author also comments on the problems of special documentation departments.

Electronic Data Processing↗
PubMedDate not supplied

[Quality assurance in endoprosthetics].

BACKGROUND: To evaluate the level of documentation as an instrument of ongoing quality management in arthroplasty, a questionnaire was created on this subject, which concentrated on structural and process indicators. METHODS: A total of 908 questionnaires was sent to orthopedic and trauma departments in Austria, Germany and Switzerland and were evaluated anonymously. RESULTS: The quota of return was 54% in Switzerland, 47% in Austria and 25% in Germany. The waiting period for an arthroplasty is much less in Switzerland and in Germany than in Austria. Only 40% of patients receive forms for informed consent. Documentation is seldomly standardized thus making comparison virtually impossible. Surgical planning is usually done with templates in Germany and Austria, in Switzerland with drawings. Prosthesis passports are predominately used by orthopedic departments. The data regarding complication rates and infections are not analyzed at regular intervals (max. 30%) and corrective measures are rarely implemented. CONCLUSION: Documentation is the basic instrument of quality management and requires completeness (totality) and plausibility of the datas. It is of great importance that evaluated data are analyzed and consequences are taken. The primary aim of quality assurance is to identify problems that adversely affect quality in order to develop and implement process sequences for the improvement of patient care and management.

Arthroplasty, Replacement↗
PubMedDate not supplied

The influence of intravenous infusions of glucose and amino acids of pancreatic enzyme and mucosal protein synthesis in human subjects.

BACKGROUND: Animal studies have shown that the synthesis and secretion of pancreatic enzymes and the turnover of mucosal proteins is strongly influenced by diet. METHODS: To determine whether the absorbed products of digestion are responsible for these changes, we investigated in groups of five healthy volunteers, the effects of i.v. infusions of amino acids (0.08 g/kg/h) and glucose (0.3 g/kg/h) on pancreatic enzyme and mucosal protein synthesis. Proteins were labeled in vivo by a 4-hours i.v. infusion of 14C-leucine and the enteric infusion of 3H-leucine tracer, during simultaneous cholecystokinin stimulation and duodenal collection of secreted pancreatic enzymes. Labeling of mucosal proteins was measured by endoscopic biopsy. RESULTS: The amino acid infusions elevated plasma amino acid levels, and the glucose infusions increased both glucose and insulin concentrations. The rates for amylase and trypsin secretion were significantly lower during the first 2 hours of glucose infusion and the rate of synthesis of trypsin was delayed by i.v. amino acid infusions from 52.1 +/- 4.1 to 77.6 +/- 8.5 minutes. Mucosal protein turnover rates were unaffected. 3H-labeling via the enteral route showed similar enzyme synthesis rates but variable mucosal incorporation rates. CONCLUSIONS: I.v. nutrients do not appear to stimulate the synthesis of pancreatic and mucosal proteins in human subjects.

Adult↗